ACT is sometimes compared with CBT to understand where the differences and similarities lie. ACT is part of the CBT family. That makes comparing ACT to CBT as comparing bananas with fruit. Yet it is true that within the CGT family the branch of Cognitive Therapy (CT) has a somewhat different approach in dealing with cognitions. Both ACT and CT recognize that people’s behavior is influenced by the way we think. It is often said that CT is concerned with changing the content of thoughts, while ACT deals with the way people relate to their thoughts. What do we mean by that?
The activities of cognitive therapists to teach someone how to deal with thoughts differently are given various names in the literature, which give rise to confusion and misunderstanding. Often it is called challenging. This can take the form of an argument. Although that is not the intention of CT, it is a pitfall. The word ‘challenge’ evokes the connotation that someone should be told how his thoughts are wrong and must be changed in terms of content. When you see cognitive therapists like Tim Beck, his daughter Judith or, for example, Christine Padesky at work, that is not what you see happening. People are invited to consider information that can help to reduce the credibility of obstructive thoughts. This often happens through a Socratic dialogue, asking questions. Cognitive therapists does not seem to believe that obstructive thoughts disappear for good and are replaced by helpful thoughts, but that someone gains access to helping thoughts, which they can consciously use at difficult times. The Socratic dialogue is based on the assumption that people already have that information at their disposal, but are not aware of it. The therapist directs the attention of someone to this information through the questions.
Within ACT we see a similar process when defusion is applied by reflecting on the workability of thoughts. Does this thought help you to move in the direction of your value? How does this thought influences your behavior? These kinds of questions are often asked within ACT. The question that ACT therapists will not be asking so quickly, and which is more common in CT, is the question: is this thought true? What is the function of this question? You can view this question as a question for truth. A truth that exists and needs to be discovered. But it can also be about inconsistency. For example, if someone is convinced that no one loves him, while he has children who say they love him, a conversation can be held about the inconsistency of his statements: they do not match each other. This is a powerful tool that can help people change the credibility of their thoughts. Within ACT less use is made of inconsistency as an instrument of change. However, work is being done to broaden the perspective. In the above example, the perspective of the children could be placed next to the perspective of the person himself. One perspective does not have to be more or less true than the other, they can coexist. This contributes to psychological flexibility. The distinction between working with inconsistency or offering multiple perspectives is subtle. Working with inconsistencies in an ACT treatment could lead to an inconsistent message: what you think is not the problem, but it is not right. This could undermine the effectiveness of defusion. Whether that is the case must be apparent from scientific research.
Because the focus of defusion is not on truth, defusion can also be applied to thoughts, the truth of which cannot be questioned. For example when someone has a life-threatening illness and struggles with the thought: I am dying. This thought is true. And at the same time, it can stand in the way of value-oriented action.
Defusion is more than just a focus on workability. It is also focusing the attention of someone on the process of thinking, for example by breaking language conventions. You learn to see someone develop the use of language and direct our thinking. Part of this way of applying defusion is learning to notice what thoughts you have and how they influence you. Although the process of thinking receives much less attention in CT than in ACT, we do see these functions in CT. In the process of cognitive restructuring, people are taught to map their thoughts and the impact on emotions and behavior is discussed. The question is whether explicit attention to the process of thinking has an added value over the more implicit way in which this is discussed within CT.
Within CT, clients are encouraged to make conscious use of helping thoughts in difficult situations. Viewed from RFT this can lead to paradoxical processes. RFT is based on reciprocity of relationships. This can lead to an unwanted thought being associated with a helping thought, the helping thought starts to evoke the unwanted thought. Someone may also feel invited to push away the unwanted thought with the helping thought. Thought suppression leads to the more prominence of the thought, which is suppressed. Yet people seem to benefit from using helping thoughts. Apparently it makes a difference how people use this strategy. It would be interesting if we knew how this came about.
There is therefore a lot of overlap between the way in which CT and ACT work with thoughts and thinking. Both help people to become aware of what they think and how this affects behaviors and emotions. Both help to focus someone’s attention on information that the person does not initially see and is often already available in this person’s repertoire. Both help people to investigate how helpful thoughts are. Both offer a different perspective.
An important difference is that ACT works less than CT with truth or inconsistency, while more and more explicit work is being done with awareness of the process of thinking and offering multiple perspectives. Whether the sometimes subtle differences between these processes influences the effectiveness of treatments will have to be investigated in scientific research.
Picture: Lorenzo Quinn Sculpture La Main de Dieu
© J. A-Tjak